Provider Demographics
NPI:1255957213
Name:BLAKE, SABRINA
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 SENECA TRL
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:WV
Mailing Address - Zip Code:24946-8602
Mailing Address - Country:US
Mailing Address - Phone:304-646-2699
Mailing Address - Fax:
Practice Address - Street 1:1070 SENECA TRL
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:WV
Practice Address - Zip Code:24946-8602
Practice Address - Country:US
Practice Address - Phone:304-646-2699
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst